March 2023 Memphis Medical News

Page 1

Hamilton Eye Institute’s Matthew Wilson, MD, Looks to Farther Horizons

No place for complacency

Dr. Matthew Wilson has witnessed significant changes in the medical landscape during the two decades he’s practiced in Memphis. Now, as the renowned ophthalmologist approaches a quarter century in the Mid-South market, he anticipates seeing even more.

Profile on page 3

The No Surprises Act is Full of Surprises

Legislation had problems from the get-go

The No Surprises Act (NSA), which went into effect Jan. 1, 2022, to protect patients from an estimated 12 million surprise bills annually, has been fraught with challenges, with medical professionals calling at least one of its processes flawed and ineffective.

Article on page 5

See more local news in Grand Rounds on page 8

2023 Legislative Priorities for TMA/Memphis Medical Society/MGMA

2023 will be a year of working to clean up, rehabilitate, and polish several areas that impact the practice of medicine. Medical groups are taking on large issues that have plagued the practice of medicine for decades and others that have popped up in the most recent year. TMA, MMS, and MGMA traveled to Nashville on March 7, to advocate for better healthcare for Tennesseans and a better environment to practice medicine in our state. As with any legislative session, things are always moving.


I like to do every day, and no two days are ever the same.”

But hump days are just different.


Arkansas > Memphis > West TN READ IT YOUR WAY! In print. Online. On your phone.
Wednesdays are special for the new chief administrative officer at Baptist Heart Institute at Baptist Memorial Hospital-Memphis. Not that Tom Wills must trudge through his other work days. As he said, “I get to do what
CAO Scrubs In Being present is part of leading
Baptist Heart Institute’s New
Tom Wills

Rice Law

For three generations, the Rices have handled divorce and family law matters in Memphis and across Tennessee. Their co-authored book, “The Complete Guide to Divorce Practice,” published by the American Bar Association, is recognized across the country as the national standard. After rigorous examination, contested case reviews, and recommendations from judges and fellow attorneys, both of the Rices are Board Certified in Family Law by the National Board of Trial Advocacy.

The Rices bring over 75 years of experience combined with up-to-date technology, including 128 bit encryption of client information and communication. Rice Law handles your family law matter with depth of experience including a team of nationally recognized attorneys and Advanced Certified Paralegals. Rice Law’s Tennessee Supreme Court Rule 31 listed mediators provide valuable insight into resolving your matter quickly.

Whether you find yourself dealing with divorce, mediation, custody, child support, domestic violence or any other matter involving family law,

memphismedicalnews com
For more information on divorce, visit or scan below. To talk to a lawyer about divorce, call 901-526-6701.
Your family’s needs are our family’s business.


Hamilton Eye Institute’s Matthew Wilson, MD, Looks to Farther Horizons

No place for complacency

Dr. Matthew Wilson has witnessed significant changes in the medical landscape during the two decades he’s practiced in Memphis. Now, as the renowned ophthalmologist approaches a quarter century in the Mid-South market, he anticipates seeing even more.

This summer, Wilson will celebrate his first anniversary as the Barrett G. Haik Endowed Chair for the Department of Ophthalmology in the College of Medicine at the University of Tennessee Health Science Center, and as the director of the Hamilton Eye Institute. In his dual roles Wilson oversees departmental goals and objectives, while developing growth strategies in clinical and academic arenas.

“It’s a bit of a juggling act because my clinical duties haven’t diminished, but I love the challenges each day brings,” Wilson said. “I’m driven by a passion to help patients suffering from the diseases I treat and for the Hamilton Eye Institute.”

Wilson arrived in Memphis from Colorado in 1999, recruited by Haik to join the program. The strategy was for Wilson to work with growing numbers of patients, help develop innovative treatments and boost medical research.

“Dr. Haik asked if I’d be interested in helping grow the program and I was excited about the opportunity,” Wilson said. “It was a tremendous undertaking, and I was honored to help create the ocular oncology program here.”

From the start, the vision was to provide a collaborative environment where academicians, medical personnel and researchers would work together to develop exemplary treatments bolstered by a first-rate medical ophthalmic education and training program.

The 60,000-square-foot Hamilton Eye Institute, which opened in 2005, is an internationally renowned facility boasting renowned faculty and medical practitioners. The state-of-the-art facility offers a 3-D surgical video system, virtual reality ophthalmic training simulators for ophthalmic surgery and indirect ophthalmoscopy, and provides laboratory research capabilities

for conditions such as age-related macular degeneration, diabetic retinopathy, dry eye disease, eye-related traumas, glaucoma, and Keratoconus.

“We’re researching to develop better treatments for conditions such as severe glaucoma that have a devastating impact on our community. Part of our mission is how to care for these conditions and provide the best visual outcomes,” Wilson said. “We have phenomenal faculty who are the lifeblood of Hamilton Eye Institute, and we all share a commitment to being a tertiary academic facility and caring for the worst of the worst conditions. Our people do this work because they’re passionate about the mission.”

In addition to being a professor at HEI and developing the ocular oncology program at the facility and at St. Jude Children’s Research Hospital, Wilson has served as director of the St. Jude Global Retinoblastoma Program. During the last two decades he has worked to establish retinoblastoma centers in Central America, the Middle East, and Southeast Asia.

“Working with St. Jude, we are committed to increasing the global survival rate of retinoblastoma,” Wilson said. “So many cases go unreported and that makes it difficult to get accurate data, but we’re putting together clinical trials with developmental drugs and working toward better outcomes.”

Ocular melanoma is another area where Wilson has noticed an increase in cases. Although it is a rare form of cancer, it is the most common form of eye cancer for adults and Wilson said the number of adults seeking treatment at HEI for the condition has substantially increased over the last two decades.

Caring for those in need drives Wilson, and he’s dedicated his career to serving those in one of the nation’s neediest communities. Numerous challenges face area residents, he said, including large numbers of uninsured and vulnerable populations,

high rates of diabetes and hypertension and damaging residual outcomes of those combined factors.

“Ideally, we want to create an umbrella in Shelby County and throughout the Mid-South so that nobody falls through these cracks with regard to eyecare,” Wilson said. “Whether it’s due to medical conditions or employers offering insurance, but without provisions for eyecare or those who are uninsured, we have to do better. We have to advocate for eyecare to be a

higher priority because loss of vision is a leading cause of loss of mobility and productivity, and increased reliance on family members and others.”

Looking ahead, Wilson said his vision is for HEI to be the center for complex ophthalmic care for Memphis, the Mid-South and the nation. He plans to build on the core faculty and attract new members – the facility added two neuro-ophthalmologists last year – and increase research and training opportunities.

“Research at Hamilton Eye Institute has flourished the last year and half and just as the department is doing well so are our research efforts that will create a landscape for the future,” Wilson said. “My pride in HEI is greater than myself – we are a family of very passionate ophthalmologists dedicated to caring for the community and educating the next generation of ophthalmologists.”

memphismedicalnews com MARCH 2023 > 3
Matthew Wilson

Legislative Priorities, continued from page 1

Abortion Trigger Law – Saving the Life of the Mother

The US Supreme Court overturned Roe v. Wade in 2022, thereby invoking the abortion “trigger law” in August. The trigger law makes most abortions illegal in Tennessee. Physicians facing terminating a pregnancy to protect the life and health of the pregnant women may face up to 15 years in prison. There is an affirmative defense which allows doctors to address life and health issues, but it can only be raised after a doctor is charged. The affirmative defense needs to be an exception to the criminal offense, which was intended to stop elective abortions. Other changes are needed in the law so physicians can feel safe addressing fetal anomalies and other common pregnancy complications. Opponents to the bill argue that no physician has been charged thus far; therefore, the law is not needed. If you were a physician, would you want even the slightest potential of a lawsuit when considering saving the life of the mother? As of this writing, SB 745 is scheduled to be heard by the Senate Judiciary Committee on March 14. There are other laws seeking to address abortion as well.

Scope of Practice

This issue is expected to rear its head once again this year, as it has every year since 2014. Tennessee Medical Association, Memphis Medical Society and many other physician groups feel a physician-led team is still the best environment for patient care in our state because it does not compromise patient safety or quality of care. Furthermore, silos and fragmentation are one of the greatest issues in healthcare today, creating unnecessary waste and fostering poor communication in healthcare systems. Nurse advocacy and physician assistant groups feel that advanced practitioners’ scopes should be expanded to allow for no physician oversight, allegedly allowing those providers to open practices in rural areas. The current laws require physician oversight of any medical clinic opened in our state. Physician groups counter that there is no evidence that expanding scope will prompt any healthcare discipline to move to a rural area, and patient safety could be compromised, particularly in more complex cases. This year, bills are also expected to address scope for “graduate physicians,” those who have

graduated medical school but not completed a residency training, and physician assistants.

Balance Billing

For years, TMA has been a member of a coalition of hospitalbased physician specialty organizations advocating for a balance billing solution that protects patients from narrow networks and ensures physicians are offered a fair, in-network rate for outof-network services. In 2020, Congress passed the No Surprises Act (NSA) to protect patients from expensive surprise bills. Unfortunately, rules implementing the federal law have led to fewer in-network healthcare options and more out-ofpocket expenses for Tennessee patients. TMA will work to implement a fair state-level solution that promotes network adequacy

patients’ best interest. SB 666 (not a typo or a joke) is the bill to keep your eye on.

Physician Wellness

TMA is working to enact safe harbor reporting systems for medical professionals to prevent physician burnout and mitigate the risk of suicide. Currently in Tennessee, some health plans and hospital credentialing committees require physicians to disclose personal mental health information to practice at facilities or serve on panels. These requirements serve as barriers to physicians seeking mental health treatment, ultimately contributing to reduced professional performance, high turnover rates, and the adverse consequences of medical errors. We hope that SB 734 comes to pass. We hope that SB 734 comes to pass to enable our medical leaders to prioritize their own mental wellbeing.

We are expanding speciality care for the uninsured.

We need you.

Time commitments are yours to decide. Many practitioners are already seeing uninsured patients. Our team can track these patients, collect all claims, and submit CME credit for the work you are already doing.

Call us today


These are the top priorities among hundreds of bills that will be filed and monitored by the advocacy team at TMA and other healthcare organizations. Other topics will include medical marijuana, gender affirmation for minors, certificate of need, and many others.

Finally, I would like to give a special shoutout the local leaders who volunteer their time to advocate on behalf of these issues. Physicians George Woodbury, MD, Dale Criner, MD, and Desiree Burroughs-Ray, MD lead the volunteer efforts locally that shape policy and facilitate conversations with our elected officials. Many more from the ranks of MGMA and local hospital leadership also lend their time and energy. Thank you!

memphismedicalnews com
Medical groups are taking on large issues that have plagued the practice of medicine for decades.

The No Surprises Act is Full of Surprises Legislation had problems from the get-go

The No Surprises Act (NSA), which went into effect Jan. 1, 2022, to protect patients from an estimated 12 million surprise bills annually, has been fraught with challenges, with medical professionals calling at least one of its processes flawed and ineffective.

“While the goals of consumer protection, price transparency, and cost concessions are important and necessary, the legislation is starting to present real challenges to practices’ financial stability,” said Dan D’Orazio, CEO of Sage Growth Partners, a national consulting firm for healthcare organizations.

The NSA applies to employersponsored health plans for certain emergency services and those received from out-of-network providers at in-network facilities regarding balanced billing. The act doesn’t apply to out-of-network providers at out-of-network facilities. Providers risk a penalty of up to $10,000 per violation.

“If a patient requests it, even physician offices are required to provide a good faith estimate,” said Matt Clements, CFO of Sage Infusion, a Type 1 diabetic well-versed in clinical visits. “One day soon, upfront pricing may be a requirement for all practices.”

The Benefit Claim Process

The benefit claim process is wieldy and time-sensitive and -consuming. When negotiation doesn’t resolve the dispute, the NSA provides for an arbitration process, Independent Dispute Resolutions (IDR).

The Centers for Medicare and Medicaid Services (CMS) anticipated 22,000 IDR appeals in 2022. Yet within the first six months of the law going into effect, more than 90,000 IDR appeals were initiated. What’s more, only 3,500 determinations had been made by mid-December.

The Trouble with IDRs

Under the IDR process, a strictly controlled baseball-style arbitration for disputing unreasonable reimbursement amounts with insurers, a provider must initiate open negotiations within 30 days of receipt of the payment or notice of denial.

Memphis Radiological Acquires Diagnostic Imaging

Memphis Radiological PC Announces The Purchase Of Diagnostic Imaging In November 2022

“If open negotiations fail, then the IDR process is initiated within four days of the end of the 30-day open negotiation period,” said Michael Lowe, a board-certified health law attorney at Lowe & Evander, PA, in Florida. “IDR is initiated by issuing notice to the other party and the HHS Secretary. The parties have three business days from the initiation of the IDR process to jointly select (the arbitrator). If the parties fail to agree on the IDR entity, then the HHS Secretary shall select the IDR entity within six business days from the initiation of the IDR process. After the IDR entity is selected, within 10 days from the selection, the parties must submit the amount(s) desired -- their offer -- along with any supporting evidence or documentation required. After the submission, the IDR entity must choose one of the two offer amounts.”

Here’s the rub: “There are only 13 IDR entities (arbitrators) and only 11 accepting new disputes, which is simply not enough,” said Christine Cooper, CEO of aequum LLC and the co-managing member of Koehler Fitzgerald LLC, a law firm with a national practice. “The IDR process is also occurring piecemeal. Appeals are initiated in the federal portal; every other step is managed by the IDR entity. Each IDR entity manages the process differently, some by email, some by their own portal. Progress is difficult to track and monitor, and some IDR entities have failed to follow deadlines.

continued on page 7

The central location at 6401 Poplar Avenue provides patients easy access to radiology services seven days a week that are convenient to both home and work. Difficult to schedule services such as MRI are offered during evenings and weekends for those that require ‘after hours’ appointments. Diagnostic Imaging offers an array of services including X-ray, CT, MRI, Ultrasound and Mammography. The brand-new state-of-the-art mammography unit has 2D and high-resolution 3D technology with smartcurve system to ensure a more accurate and comfortable exam. Their commitment to patient care includes subspecialized radiologists and a physician portal that expedites scheduling and precertification of exams as well as transmitting and reviewing results. In addition, the patients can register online to reduce waiting room time and have the option to request their imaging report be sent directly to them from a secure site built specifically for patient privacy.

The radiologists enjoy meeting physicians in the area and welcome the opportunity to explore new ways to serve the community while upholding the legacy of high-quality affordable care.

memphismedicalnews com MARCH 2023 > 5
Schedule an imaging study or inquire about the services. 901-387-2340 | 901-680-1902 (fax) Diagnostic Imaging 6401 Poplar Ave., Suite 100, Memphis, TN 38119
Christine Cooper

Baptist Heart Institute’s New CAO, continued

“Every Wednesday I try to put scrubs on and try to do something,” said Wills, a veteran healthcare executive who rose from the nursing ranks. Wills remains as comfortable in hygienic medical uniforms as a suit and tie.

His Wednesday routine is not about keeping up his nursing skills but keeping in touch with the front line of patient care at the comprehensive cardiovascular medical provider.

“I’ll go to the cardiac catheterization laboratory, I’ll go to the electrophysiology lab, I’ll go to the operating room, I’ll go around to the intensive care unit and check on the nurses,” Wills said. “I just try to get out of the office and go where the doctors are.”

Pinnacle of cardiovascular services

Wills is an Army veteran who has 29 years of experience in health care, including as a critical-care nurse. He arrived last summer at Baptist Heart Institute.

“I’d call it the pinnacle of cardiovascular services,” he said of his organization.

The institute provides everything from heart transplants — two transplant surgeons are on staff — and implanted ventricular-assist devices, to treatment for myocardial infarction, aka heart attacks.

“So, we provide from the beginning to the ultimate of cardiovascular services,” he said.

In the last fiscal year that ended Oct. 1, doctors at the heart institute performed 31 ventricular-assist device implants and 20 heart transplants.

This fiscal year, the institute has a goal to perform 35 ventricular assist device implants. Eight were completed by mid-February. Meanwhile, the institute had performed five heart transplants since Oct. 1 with a goal of doing 25 this fiscal year.

To reach those goals, Wills said, “you have to have a robust system that brings referrals. So, it’s a really delicate dance of education and outreach and awareness, and that’s what we’re really trying to focus on this year.”

A culture, not walls

Wills estimates the number of fulltime equivalent employees involved with the institute to be nearly 1,000, but counting is complex. Physical space, or walls, don’t define the institute. “Our institute spans everything from partnership with our Emergency Department staff and physicians all the way to our transplant ICU nurses and patient-care assistants,” he said.

The institute also partners with Stern Cardiovascular, bringing another 90-plus providers.

The heart institute, he said, “is more a culture of how we take care of

our patients. We have all our employed providers that are hospitalists who help take care of our patients at the bedside in addition to all our Stern Cardiovascular partners. We have our Baptist Medical Group partners, and we have Memphis Lung, which is our pulmonary intensivist group that we work closely with.”

Nursing looked more exciting Service in the military as well as in health care runs deep in Wills’ family. His father is a retired military officer, and Wills followed in his footsteps by joining the Army during his college years. He retired from the Army after 25 years in the infantry and Army Nurse Corps. He earned a nursing degree from Methodist Hospital School of Nursing in Lubbock, Texas, a bachelor of science degree in nursing from the University of Texas at Austin and a master’s in public and private management from BirminghamSouthern College.

Wills initially intended to be a physical therapist, but switched to nursing after meeting his future wife, Michelle, a nursing school student. To him, her career path “looked more exciting than mine,” he recalls.

He eventually transitioned into management for a simple reason: “By supporting the staff that was by the bedsides I can make decisions that affect hundreds of patients a day rather than six or seven,” he said.

The couple has two adult children, Matthew, who is serving overseas in the Army, and Grace, who recently graduated from nursing school.

Wills came to Baptist Heart Institute after seven years in Jackson, Miss., first as executive director of University Heart Services at the University of Mississippi Medical Center and more recently as chief operating officer at Merit Health. Previously, he held leadership roles at major healthcare organizations such as HCA Healthcare and Tenet Healthcare.


His hands-on regimen on Wednesdays does not mean that Wills micromanages.

“I actually describe my philosophy as macromanagement, which is the whole other spectrum,” he said. “I try to lead by empowering the people who report to me to do their very best, by allowing them to do their job and not have me to tell them how to do their job.”

Even when employees might make “marginal decisions” when there’s no time for them to call for help, “you can’t chop their knees out from under them,” Wills said. He has never forgotten what a West Texas cardiologist told him years ago: “Good judgment comes from bad experience from bad judgment.”

from page 1

His leadership style places a premium on recruiting and retaining high-quality nurses, doctors and other team members.

Wills cited an important resource for retaining staff: The culture at Baptist Memorial Hospital. “Baptist is very different,” he said. “I’ve worked for three of the top four health care companies in the country during my career. One thing I can unequivocally tell you is that Baptist is different. They treat their employees different.”

For example, Wills said, “We start our major senior meetings with prayer. I have been at just one other facility that did that. That’s unique in today’s world.”

And, he said, the hospital is “just very transparent.” For example, Wills said, Baptist Memorial Health Care president and chief executive Jason Little shares information “at a different level than other corporate CEOs I’ve seen. It’s just a real cool environment.”

The heart institute claims the distinction of offering the Mid-South’s only certified programs for adult heart transplants and for extracorporeal membrane oxygenation, which uses two large intravenous lines to remove the patient’s blood, oxygenate it, and return the blood to the patient.

Growth and new technology

The institute is carrying out a number of technology and strategic initiatives, including the relatively new Barostim implant treatment. The therapy stimulates the body’s natural sensors to tell the brain how to regulate the heart, relieving symptoms of heart failure. “We’ve done some treatments with patients here and have had very good outcomes,” Wills said. “It’s not done everywhere. We’re working on some stories to get that out to the public.”

The heart institute also will hire a new outreach coordinator as it continues expanding its Mid-South footprint. A new outreach clinic was to open in March in Tupelo, Miss., in partnership with Tupelo-based Cardiology Associates of North Mississippi.

“We were asked to come and provide an additional, higher level of care,” Wills said. “They referred us a couple of patients who we did very well with. We treated them and referred them back to their primary cardiologist.

“And that’s what we want to be, is the specialist. The last thing we want to do is steal patients,” he said.

God’s work

Among the specialists at the heart institute is surgeon Dr. H. Edward Garrett Jr., whom Wills got to watch in action during one of his Wednesday scrubs days.

“Sometimes I have a hard time just talking and walking,” which is not the case

for the surgeons like Garrett, Wills said. “Until you stand next to someone who is actually delivering the care, I don’t think you really appreciate” their skills, he said.

“Dr. Garrett, he was raised in Texas, so we talk about music and Texas things. So, he’ll be standing there sewing a bypass vessel onto someone’s heart and we’ll be talking about music… And he doesn’t miss a beat.

“Dr. Garrett, Dr. Brad Wolf, Dr. Brian Bruckner, all these guys are just so good.

“It’s really humbling to see those guys work and to know they are doing God’s work and taking care of people.”


Pamela Z. Haskins



Greg Campbell



Pamela Z. Haskins



Tom Bailey Clint Cummins, MHA James Dowd Lynne Jeter

All editorial submissions and press releases should be sent to

Subscription requests can be mailed to the address below or emailed to

Memphis Medical News© is now privately and locally owned by Ziggy Productions, LLC. P O Box 164831 Little Rock, AR 72206

President: Pamela Z. Haskins

Vice President: Patrick Rains

Reproduction in whole or in part without written permission is prohibited. Memphis Medical News will assume no responsibility for unsolicited materials. All letters sent to Memphis Medical News will be considered the newspaper’s property and unconditionally assigned to Memphis Medical News for publication and copyright purposes.

6 > MARCH 2023 memphismedicalnews com

The No Surprises Act, continued from page 5

Rather, they pause the acceptance of offers upon receipt of new disputes. It’s been very difficult to communicate with the IDR entities, as most don’t respond to phone calls or emails.”

Physicians will not only need to become savvy at submitting bids to receive more favorable reimbursements, but also because the loser in the arbitration may be required to cover fees for both parties, said D’Orazio.

To add to the uncertainty, the IDR rules keep changing.

“Early (in 2022), several state medical associations and air ambulance companies filed suits about the interim final rule that bases appropriate reimbursements on insurers’ qualifying payment amounts (QPA),” he said. “In April, CMS retracted its stance on just how much weight QPAs should carry in arbitrators’ decision-making.”

More Legal Woes

Last February, Eastern District of Texas Judge Jeremy Kernodle agreed with the Texas Medical Association that the Department of Health and Human Services (HHS) interim final rule governing the IDR process conflicted with the NSA statute when it created a rebuttable presumption that the QPA was the correct out-ofnetwork rate for purposes of the IDR process, explained Cooper.

In September, the Tennessee Advisory Commission on Intergovernmental Relations revealed that it was studying “the overall effect on health insurance prices when reference-based pricing is used.” Tennessee may be the latest state to adopt reference-based pricing to control healthcare costs, noted Cooper. (The final report had not been presented by press time.)

“Several other states have adopted reference-based pricing and are successfully using it,” said Cooper. “The most well-known is Montana, which became the first state to use reference-based pricing for all of its employees’ health benefits. Other states that have adopted referencebased pricing include California, Oregon, Colorado, and Washington. Each of these states was armed with the experience of Montana.”

Reference-based pricing is a way to avoid the uncertainty the NSA is creating, said Cooper.

“We anticipate seeing a broader adoption of reference-based pricing plan design both for public entities and private corporations,” she said. “It’s a true cost control mechanism that brings uncertainty to the plans and the providers.”

Woes Before NSA Became Law

In November 2021, congressional doctors, their medical associations and members of Congress led the charge that the rule released by the Biden Administration two months earlier for implementing the law, favored insurers and didn’t follow the spirit of the legislation, wrote Michael McAuliff for Kaiser Health News.

“The Administration’s recently proposed regulation to begin implementing the law doesn’t uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close, thus limiting patients’ access to care,” wrote Rep. Larry Bucshon (R-Indiana). Roughly half of the 152 lawmakers who signed the letter were Democrats.

“The doctors in Congress are furious about this,” a staff member told McAuliff.

Cooper said it was clear that providers would take issue with the language in the Rule creating a rebuttable presumption that the payor’s median contracted rate is the proper reimbursement rate for claims governed by the NSA, ignoring the other factors listed in the NSA.

“The median contracted rate is solely within control of the payors and it stripped the providers of any say,” said Cooper. “In addition, the providers likely understood that the IDR entities would naturally select the offer closest to the median contracted rate because they’re on a tight timeline and couldn’t reasonably process the number of claims they would be receiving if they had to evaluate each factor listed in the NSA and provide a written opinion as to why they deviated from the median contracted rate.”

memphismedicalnews com MARCH 2023 > 7
Reference-based pricing is a way to avoid the uncertainty the NSA is creating.
– Christine Cooper, CEO, Aequum LLC, Co-Managing Member, Koehler Fitzgerald LLC


Methodist Le Bonheur Healthcare Reaches Agreement on BlueCare and TennCare Plans

Methodist Le Bonheur Healthcare announced it has reached an agreement regarding certain BlueCare Tennessee plans.

BlueCare Tennessee, TennCare Select, CoverKids and Dual Special Needs Plan (D-SNP) members will again receive in-network coverage at Methodist Le Bonheur Healthcare facilities, including Le Bonheur Children’s Hospital. These changes are effective immediately.

“Providing the safest and highest quality care to our community, especially our most vulnerable patients, remains our top priority,” said Michael Ugwueke, president and CEO of MLH. “This agreement, while a major step forward, represents a fraction of what we can accomplish when insurance companies put the interests of their patients first. We look forward to continued negotiations to return insurance coverage to all of the BCBST members we are so privileged to serve.”

TennCare covers healthcare services for mostly low-income pregnant women, parents or caregivers of minor children, as well as children and individuals who are elderly or have a disability.

Methodist Le Bonheur Healthcare leaders continue to strive for a reasonable agreement with BCBST, while it continues its gamesmanship, catching patients in the middle. Its claims of relying on other facilities for care are not working. This is one of the reasons we pushed for this agreement with TennCare and BlueCare, to help alleviate the burden on those we serve.

The fact is, BCBST does not have a sufficient network capable of handling the volume of patients that MLH hospitals treat in our community.

While we are delighted to get this accomplished on behalf of TennCare patients, we will continue to fight for the interest of the thousands of BCBST patients in our community who remain out of network.

Regional One Health’s Center for Innovation Gains New Innovator: Augment Health’s Smart Bladder Monitor

Regional One Health’s Center for Innovation is working with its newest innovator, Augment Health, on the company’s journey to bring its smart bladder monitor to market. Augment Health is taking advantage of the Center for Innovation’s Healthcare Startup Access Incubator program to gather the data it needs regarding product development and support business and distribution model optimizations for its smart bladder monitor.

“This scope of incubation is a little different, because Augment Health is in the middle of finalizing their prototype. Therefore, a lot of the feedback they are seeking will be from both the clinical and business side of the organization,” said Alejandra Alvarez, Center for Innovation director at Regional One Health.

Alvarez believes incubation is applicable at any point, and this newest partnership lets the Center for Innovation cover another aspect of the development cycle.

“We’re excited for the opportunity, because we want to be able to support all stages of development,” said Alvarez. “We don’t know of anyone else out there that is doing that, and it is an important service for entrepreneurs.”

Augment Health is a Nashville-based startup and a graduate of Memphis’ ZeroTo510 health care accelerator. They are developing a system that includes an electronic sensor to monitor bladder fullness and other bladder health parameters along with a clinician-facing dashboard that will support improved treatment outcomes and dignity.

For patients with neurogenic bladder, a condition that impacts bladder sensation and control due to brain, spinal cord or nerve problems, bladder issues can lead to embarrassing events, inconvenience, and even kidney damage.

Augment Health’s technology would replace the urine bag with a small electronic sensor that remotely monitors

bladder activity and supports clinician decision making by communicating information about key events.

“The goal is to improve a patient’s quality of life by introducing a smart bladder monitor to track bladder fullness and other bladder health parameters,” Alvarez said.

Currently, she said, Augment Health’s prototype is in development and they are working to communicate with the FDA to streamline their market entry process. Therefore, their partnership with the Access Incubator will provide both clinical and business feedback.

The product will not be used with patients, but Regional One Health providers in relevant areas like urology and inpatient and outpatient rehabilitation will provide feedback about the design and how they would use the product with patients.

“Augment Health will seek to understand the clinical standards of care for these patients and see whether their product design meets that model,” Alvarez explained.

A large portion of the evaluation will be on the business side of the hospital.

Augment Health’s business development function will meet with staff in procurement, billing, materials management and other areas of the operation to get answers to important questions.

For example, they want to understand the clinic inventory management process, how it would fit into the typical outpatient care for patients with neurogenic bladder, how the product would be ordered and billed, etc.

Alvarez expects it will take about six months to complete the current scope of the partnership.

Learn more about the Center for Innovation:

Methodist Le Bonheur Healthcare names Dr. Jason Vanatta Program Director of Methodist Transplant Institute

Methodist Le Bonheur Healthcare (MLH) recently announced the appointment of Jason Vanatta, MD, to program director of its transplant institute. Vanatta assumes the role after serving as interim director since August. A veteran of MLH, Vanatta previously held the position of the transplant institute’s surgical director of liver transplantation. He also is the endowed chair for Excellence in Liver Transplantation at the University of Tennessee Health Sciences Center (UTHSC).

“Dr. Vanatta is an exceptional surgeon with a distinguished career spanning two decades,” said Michael Ugwueke, DHA, FACHE, MLH president and CEO. “His engaging style of leading from behind to drive collaboration and innovation, coupled with a passion and commitment to eliminating health disparities in our community, will help ensure our transplant program continues to deliver high quality care to anyone who enters our doors.”

“I’ve had the privilege of working with the incredibly dedicated and nationally-recognized team at this distinguished institute for more than a decade,” said Vanatta. “It’s an honor to serve as program director and I look forward to continuing to build on our legacy of bringing life-saving treatment to patients across the Mid-South.”

Vanatta returned to MLH in September 2020 after a stint as a transplant surgeon at the Cleveland Clinic (Florida) Transplant Center. As part of a cooperative agreement between MLH and UTHSC, Vanatta also worked as a transplant surgeon at St. Thomas Health (Nashville). He was a member of MLH’s transplant institute’s surgical team from 2007-2017. He has been a member of the surgical teams of Stanford Hospital and Clinics, Baptist Memorial Health Care and Lucile Packard Children’s Hospital. Vanatta also has held medical and clinical faculty positions at Florida Atlantic University, Ross University and UTHSC.

8 > MARCH 2023 memphismedicalnews com When It Comes To Your Medical Practice’s Computer System Downtime = $$,$$$.$$ 901.466.6358 | Local | Dependable Microsoft Certified Over 20 years IT experience Former Systems Admin for UTHSC & US NAVY Network Security Call John Pantall 901.466.6358 Cybersecurity Threats Ransomware | Insider Threats Other money grabbers: G. Coble Caperton Licensed Tennessee Attorney 37 years of experience Practicing in the following areas: • Business and Commercial Law • Family Law • Personal Injury • Contracts Rule 31 General Civil/Family Mediator 901.526.6701